Variables influyentes en los niveles de 25(OH)D total y libre en población sana / Influencing variables on total and free 25(OH)D levels in healthy population

Introducción La vitamina D ejerce un papel fundamental en la homeostasis del calcio y el metabolismo óseo. Procede, mayoritariamente, de la síntesis cutánea, por acción de la luz solar. Así, variaciones en la exposición a esta radiación modifican sus niveles séricos. Estudiamos dos analitos diferentes de vitamina D en población sana española, y la influencia de la estacionalidad, el clima y la latitud en sus estatus. Métodos Estudio descriptivo, transversal. Se incluyeron 206 donantes de sangre de Burgos y Valencia de 18-60 años durante marzo-abril y octubre-noviembre de 2018. Se analizaron las concentraciones séricas de 25-hidroxicolecalciferol (25(OH)D) total y libre. Resultados Las concentraciones medias de 25(OH)D total y libre tras el verano en Burgos fueron: 24,31 ± 5,25 ng/mL y 5,01 ± 1,25 pg/mL; y en Valencia: 25,99 ± 6,87 ng/mL y 8,97 ± 2,82 pg/mL. Tras el invierno, los resultados en Burgos fueron: 17,66 ± 5,04 ng/mL y 4,08 ± 0,66 pg/mL, y en Valencia: 21,38 ± 3,77 ng/mL y 7,23 ± 2,44 pg/mL. Los cambios estacionales resultaron estadísticamente significativos para los dos componentes estudiados, tanto de manera global como en ambas poblaciones por separado. Las diferencias poblacionales en los niveles de 25(OH)D total y libre resultaron estadísticamente significativas, excepto en 25(OH)D total tras el verano (24,07 ng/mL vs. 26,03 ng/mL; p = 0,408). La latitud también demostró ser un factor influyente en las concentraciones de ambos analitos, en verano e invierno. Conclusiones Nuestro estudio refleja niveles de vitamina D más bajos de lo esperable tratándose de población sana española. Se demuestra la influencia de la estacionalidad, el clima y la latitud en los niveles de 25(OH)D total y 25(OH)D libre (AU)

Introduction Vitamin D plays a fundamental role in calcium homeostasis and bone metabolism. It mainly comes from cutaneous synthesis through the action of sunlight. Therefore, variations in exposure to this radiation modify serum levels. We studied two different analytes of vitamin D in the healthy Spanish population and the influence of seasonality, climate, and latitude on its levels. Methods This work is a cross-sectional, descriptive study. A total of 206 blood donors from Burgos and Valencia between 18-60 years of age were recruited during March-April and October-November 2018. Total and free serum 25-hydroxycholecalciferol (25(OH)D) were analyzed. Results After summer, total and free serum 25(OH)D medium levels were 24.31 ± 5.25 ng/mL and 5.01 ± 1.25 pg/mL in Burgos and 25.99 ± 6.87 ng/mL and 8.97 ± 2.82 pg/mL in Valencia. After winter, they were 17.66 ± 5.04 ng/mL and 4.08 ± 0.66 ng/mL in Burgos and 21.38 ± 3.77 ng/mL and 7.23 ± 2.44 ng/mL in Valencia. The seasonal changes were statistically significant for both components studied both in the sample as a whole and in the separate populations. The differences found between the two populations in total and free 25(OH)D levels were statistically significant except for total 25(OH)D after summer (24.07 ng/mL vs. 26.03 ng/mL; p = 0.408). Latitude was also shown to be a factor that influences concentrations of both analytes in summer and winter. Conclusions Our study shows lower vitamin D levels than expected for a healthy Spanish population. Seasonality, climate, and latitude were demonstrated to influence total and free 25(OH)D levels (AU)

Influencing variables on total and free 25(OH)D levels in healthy population.

INTRODUCTION: Vitamin D plays a fundamental role in calcium homeostasis and bone metabolism. It mainly comes from cutaneous synthesis through the action of sunlight. Therefore, variations in exposure to this radiation modify serum levels. We studied two different analytes of vitamin D in the healthy Spanish population and the influence of seasonality, climate, and latitude on its levels. METHODS: This work is a cross-sectional, descriptive study. A total of 206 blood donors from Burgos and Valencia between 18-60 years of age were recruited during March-April and October-November 2018. Total and free serum 25-hydroxycholecalciferol (25(OH)D) were analyzed. RESULTS: After summer, total and free serum 25(OH)D medium levels were 24.31 ±â€¯5.25 ng/mL and 5.01 ±â€¯1.25 pg/mL in Burgos and 25.99 ±â€¯6.87 ng/mL and 8.97 ±â€¯2.82 pg/mL in Valencia. After winter, they were 17.66 ±â€¯5.04 ng/mL and 4.08 ±â€¯0.66 ng/mL in Burgos and 21.38 ±â€¯3.77 ng/mL and 7.23 ±â€¯2.44 ng/mL in Valencia. The seasonal changes were statistically significant for both components studied both in the sample as a whole and in the separate populations. The differences found between the two populations in total and free 25(OH)D levels were statistically significant except for total 25(OH)D after summer (24.07 ng/mL vs. 26.03 ng/mL; p = .408). Latitude was also shown to be a factor that influences concentrations of both analytes in summer and winter. CONCLUSIONS: Our study shows lower vitamin D levels than expected for a healthy Spanish population. Seasonality, climate, and latitude were demonstrated to influence total and free 25(OH)D levels.

Gastroenteropatía pierde proteínas: ¿causa olvidada de hipoalbuminemia? / Protein-losing gastroenteropathy: unremembered cause of hypoalbuminemia?

La gastroenteropatía pierde proteínas (PLE) es un síndrome que consiste en una pérdida activa proteica por el aparato digestivo y relacionada con enfermedades. Tras revisión amplia de la literatura (MEDLINE - PubMed),hemos encontrado escasas referencias de esta gastroenteropatía como causante de hipoalbuminemia asociada a desnutrición. Ello nos ha motivado para revisar la entidad y su diagnóstico, detallando algunos casos clínicos recientes de nuestra experiencia (AU)

Protein-losing gastroenteropathy (PLE) consists on anactive digestive tract protein loss syndrome and it is related to some diseases. After a wide research into bibliography (MEDLINE - Pubmed),we have found few references to this gastroenteropathy as a cause of hypoalbuminemia related to malnutrition. This has motivated us to review this entity, detailing some recent clinical cases of our experience (AU)

Investigación en nutrición: de la clínica a la mejor evidencia científica / No disponible

No disponible

[Protein-losing gastroenteropathy: unremembered cause of hypoalbuminemia?]. / Gastroenteropatía pierde proteínas: ¿causa olvidada de hipoalbuminemia?

Protein-losing gastroenteropathy (PLE) consists on an active digestive tract protein loss syndrome and it is related to some diseases. After a wide research into bibliography (MEDLINE - Pubmed),we have found few references to this gastroenteropathy as a cause of hypoalbuminemia related to malnutrition. This has motivated us to review this entity, detailing some recent clinical cases of our experience.

Tratamiento nutricional en la enfermedad inflamatoria intestinal / Nutritional management of inflammatory bowel disease

Los pacientes con enfermedad inflamatoria intestinal presentan mayor riesgo de malnutrición. Por este motivo es muy frecuente que se precise un adecuado soporte nutricional. En estos pacientes se debe utilizar la nutrición enteral a menos que existan contraindicaciones. El soporte nutricional como tratamiento primario no está indicado en adultos (al haberse demostrado una mayor eficacia del tratamiento esteroideo) salvo en caso de intolerancia o falta de respuesta al tratamiento médico. Por el contrario, la nutrición enteral se considera el tratamiento de primera línea en niños. No existe un claro beneficio con el uso de fórmulas específicas (grasa modificada, glutamina...) por lo que no se aconseja su uso rutinario. A pesar de los grandes avances técnicos y científicos existen aún numerosos campos en los que ampliar conocimientos; algunos de los mismos se esbozan en la presente publicación (AU)

Patients with inflammatory bowel disease present higher risk for hyponutrition. For this reason, an adequate nutritional support is frequently needed. In these patients, enteral nutrition should be used unless there exist contraindications. Nutritional support as the primary therapy is no indicated in adults (since steroidal therapy has shown to be more effective) but in the case of intolerance or lack of response to medical treatment. By contrast, enteral nutrition is considered a first line therapy in children. There is no clear benefit with the use of specific formulas (modified fat, glutamine...), so that their routine use is not recommended. In spite of the great technical and scientific advances, there are still many fields in which knowledge should be broaden; some of them are pointed out in this publication (AU)

[Nutritional management of inflammatory bowel disease]. / Tratamiento nutricional en la enfermedad inflamatoria intestinal.

Patients with inflammatory bowel disease present higher risk for hyponutrition. For this reason, an adequate nutritional support is frequently needed. In these patients, enteral nutrition should be used unless there exist contraindications. Nutritional support as the primary therapy is no indicated in adults (since steroidal therapy has shown to be more effective) but in the case of intolerance or lack of response to medical treatment. By contrast, enteral nutrition is considered a first line therapy in children. There is no clear benefit with the use of specific formulas (modified fat, glutamine...), so that their routine use is not recommended. In spite of the great technical and scientific advances, there are still many fields in which knowledge should be broaden; some of them are pointed out in this publication.

Nutrición artificial y pancreatitis aguda: revisión y actualización / Artificial nutrition and acute pancreatitis: a review and update

La mayoría de los casos de pancreatitis aguda se presentan como formas leves, en las que no se recomienda el soporte nutricional, a no ser que los pacientes no puedan reanudar su alimentación oral normal después de 5-7 días. Por el contrario, la pancreatitis grave cursa con estrés metabólico, y precisa de soporte nutricional precoz. En estos casos, se recomienda nutrición enteral, que debe complementarse con nutrición parenteral si es preciso. Estudios recientes indican que la nutrición enteral puede mejorar la evolución de la pancreatitis aguda grave, reducir las complicaciones y favorecer una recuperación más rápida de la enfermedad. La mayoría de los pacientes toleran una nutrición enteral oligomérica administrada en infusión continua distalmente al ángulo de Treitz. Estudios recientes apuntan, sin embargo, que la perfusión intragástrica es segura y puede ser una buena opción terapéutica en determinados pacientes con pancreatitis aguda grave. Además, agentes específicos añadidos a la nutrición (inmunomoduladores y probióticos) parecen reducir la estancia hospitalaria y las complicaciones infecciosas y no infecciosas de la pancreatitis aguda

Most of acute pancreatitis cases present as mild cases for which nutritional support is not recommended provided the patient is able to restart normal oral intake within 5- days. By contrast, severe pancreatitis associates metabolic stress and requires early nutritional support. In these cases, enteral nutrition is recommended, which should be supplemented with parenteral nutrition if needed. Recent studies indicate that enteral nutrition may improve the course of severe acute pancreatitis, reduce its complications and promote a quicker improvement from the disease. Most of the patients tolerate oligomeric nutrition administered as continuous infusion distally to the Treitz’ s angle. Recent studies show, however, that intragastric perfusion is safe and may be an adequate therapeutic option in particular patients with acute severe pancreatitis. Besides, specific agents added to the nutrition (immunomodulators and probiotics) seem to reduce hospital stay and infectious and non-infectious complications of acute pancreatitis

[Artificial nutrition and acute pancreatitis: a review and update]. / Nutrición artificial y pancreatitis aguda: revisión y actualización.

Most of acute pancreatitis cases present as mild cases for which nutritional support is not recommended provided the patient is able to restart normal oral intake within 5- days. By contrast, severe pancreatitis associates metabolic stress and requires early nutritional support. In these cases, enteral nutrition is recommended, which should be supplemented with parenteral nutrition if needed. Recent studies indicate that enteral nutrition may improve the course of severe acute pancreatitis, reduce its complications and promote a quicker improvement from the disease. Most of the patients tolerate oligomeric nutrition administered as continuous infusion distally to the Treitz' s angle. Recent studies show, however, that intragastric perfusion is safe and may be an adequate therapeutic option in particular patients with acute severe pancreatitis. Besides, specific agents added to the nutrition (immunomodulators and probiotics) seem to reduce hospital stay and infectious and non-infectious complications of acute pancreatitis.

[Pica: the portrait of a little known clinical entity]. / La pica: retrato de una entidad clínica poco conocida.

Pica is a eating disorder, of the eating behavior in childhood. It is defined as the persistent intake of non-nutritional substances for at least one month, in an inappropriate way from an evolutionary perspective, and provided that its practice is not culturally banned. Many animal species, including primates, have this behavior. Documented from antiquity, in most cases it has been considered a symptom of another related disorder rather than as independent condition. Its prevalence is unknown. It is mainly described in mentally disabled people, pregnant women, autism, mentally ill patients, children, and others. The ingestion of earth, ice, starch, ropes, wood, and other products has been observed, although some authors also include the obsessive and reiterative consumption of eatable substances. Geophagia is considered a cultural phenomenon, although sometimes may lead to disease, and an form of paleomedicine or paleonutrition. The etiology of pica is unknown and it has no markers. Sensitive, digestive, nutritional, psychological, and psychiatric factors have been implicated in its origin and maintenance. Although the morbimortality is unknown and difficult to study, we may highlight intoxications, parasitic diseases, and surgical abdomen with serious complications. Finally, as in other eating behavior disorders, the global management of this entity requires a coordinated intervention of different health care professionals.

La pica: retrato de una entidad clínica poco conocida / Pica: the portrait of a little known clinical entity

La Pica es un trastorno de la ingestión y de la conducta alimentaria de la infancia o la niñez. Se define como el consumo persistente de sustancias no nutritivas durante un período de por lo menos un mes, de forma inadecuada evolutivamente y siempre que su práctica no esté sancionada culturalmente. Muchas especies animales, incluidos primates, presentan este comportamiento. Documentado desde la antigüedad, en la mayor parte de los casos, se ha considerado más como síntoma de otro trastorno o estado que como entidad independiente. No se conoce la prevalencia. Se describe sobre todo en discapacitados intelectuales, embarazadas, autistas, enfermos mentales, niños y otros. Se ha observado ingesta de tierra, hielo, almidón, cuerdas, madera, y otros productos, incluyendo algunos autores en este contexto el consumo obsesivo y reiterado de sustancias comestibles. La geofagia como fenómeno cultural, aunque a veces ocasiona enfermedad, es considerada como una forma de paleomedicina o paleonutrición. Se desconoce la causa de la Pica como trastorno y no existen marcadores de la misma. Factores sensoriales, digestivos, nutricionales, psicológicos y psiquiátricos se han implicado en su origen y mantenimiento. Aunque la morbi-mortalidad es desconocida y difícil de estudiar, destacan las intoxicaciones, parasitosis y el abdomen quirúrgico como complicaciones graves. Por último, al igual que el resto de los trastornos de la alimentación, el manejo global de esta entidad requiere la intervención coordinada de diversos profesionales de la salud (AU)

Pica is a eating disorder, of the eating behavior in childhood. It is defined as the persistent intake of non-nutritional substances for at least one month, in an inappropriate way from an evolutionary perspective, and provided that its practice is not culturally banned. Many animal species, including primates, have this behavior.Documented from antiquity, in most cases it has been considered a symptom of another related disorder rather than as independent condition. Its prevalence is unknown. It is mainly described in mentally disabled people, pregnant women, autism, mentally ill patients, children, and others. The ingestion of earth, ice, starch, ropes, wood, and other products has been observed, although some authors also include the obsessive and reiterative consumption of eatable substances. Geophagia is considered a cultural phenomenon, although sometimes may lead to disease, and an form of paleomedicine or paleonutrition.The etiology of pica is unknown and it has no markers. Sensitive, digestive, nutritional, psychological, and psychiatric factors have been implicated in its origin and maintenance. Although the morbimortality is unknown and difficult to study, we may highlight intoxications, parasitic diseases, and surgical abdomen with serious complications. Finally, as in other eating behavior disorders, the global management of this entity requires a coordinated intervention of different health care professionals (AU)

Eficacia-utilidad del soporte nutricional en el paciente neoplásico / No disponible

No disponible

[The zinc status in a selected Spanish population. A multivariate analysis]. / Status de zinc en una población española seleccionada. Análisis multivariante.

There are no previous studies on the zinc status in the healthy, adult, Spanish population. The objective of this study was to obtain the levels of zinc in the serum and hair of this population to determine the normal nutritional status of zinc, and evaluating the influence of certain factors like age, sex, type of residence, body mass index (BMI) hair color, or recent food intake (zinc and fiber contents of the diet) on this status. Using a simple randomized sampling, 186 blood donors of both sexes with ages comprised between 18 and 65 years, were selected. The results were analyzed using uni- and multi-variate statistical techniques. The average concentration of zinc in serum was 97.22 micrograms/dl (95% CI: 95.1-99.4); the average zinc level in hair was 163.86 micrograms/g (95% CI: 157.8-169.9). The serum zinc was individually associated with the type of residence and the zinc and fiber contents of the diet. The zinc in hair was associated with sex, age, body mass index, and hair color. Using a multivariate analysis, predictive models of multiple regression were obtained for the serum zinc: y = 109.69 - 1.39 (dietary zinc) - 4.63 (sex) - 0.65 (dietary fiber), for the zinc in the serum, and y = 199.34 + 26.62 (sex) - 2.08 (BMI) - 0.47 (age) for the zinc in the hair. The serum concentration decreases as the dietary zinc and fiber decreases and women have lower levels. The zinc in hair is increased in women and is reduced with increasing age and BMI.

Status de zinc en una población española seleccionada. Análisis multivariante / Zinc status in a selected Spanish population. Multivariant analysis

No existen estudios previos sobre la determinación del status de zinc en la población adulta española sana. El objetivo de este estudio fue obtener los niveles de zinc en suero y cabello en esta población para poder determinar el status nutricional normal de zinc, evaluando la influencia sobre estos valores de determinados factores, como edad, sexo, tipo de residencia, índice de masa corporal (BMI), color de pelo o ingesta reciente (contenidos de zinc y fibra de la dieta). Mediante muestreo aleatorio simple se seleccionaron 186 donantes de sangre de ambos sexos, con edades comprendidas entre los 18 y 65 años. Los resultados fueron analizados mediante técnicas de estadística un¡- y multivariante. La concentración media de zinc en suero fue de 97,22 ug/dl (IC 95 por ciento : 95,1 - 99,4); los niveles medios de zinc en cabello fueron de 163,86 ug/g (IC 95 por ciento: 157,8 - 169,9). El zinc sérico se asoció individualmente con el tipo de residencia y con los contenidos de zinc y fibra de la dieta. El zinc en cabello se asoció con el sexo, edad, índice de masa corporal y color del pelo. Mediante análisis multivariante se obtuvieron modelos predictivos de regresión múltiple para el zinc en suero: y = 109,69 - 1,39 (zinc dieta) - 4,63 (sexo) - 0,65 (fibra dieta), para el suero, e y = 199,34 + 26,62 (sexo) - 2,08 (BMI) - 0,47 (edad) para el zinc en cabello. La concentración sérica de zinc disminuye la medida que decrece el zinc y la fibra de la dieta y con el sexo femenino. El zinc en cabello aumenta con el sexo femenino y se reduce con la edad y el BMI (AU)

There are no previous studies on the zinc status in the healthy, adult, Spanish population. The objective of this study was to obtain the levels of zinc in the serum and hair of this population to determine the normal nutritional status of zinc, and evaluating the influence of certain factors like age, sex, type of residence, body mass index (BMI) hair color, or recent food intake (zinc and fiber contents of the diet) on this status. Using a simple randomized sampling, 186 blood donors of both sexes with ages comprised between 18 and 65 years, were selected. The results were analyzed using uni- and multi-variate statistical techniques. The average concentration of zinc in serum was 97.22 μg/dl (95% CI: 95.1 — 99.4); the average zinc level in hair was 163.86 μg/g (95% CI: 157.8 —169.9). The serum zinc was individually associated with the type of residence and the zinc and fiber contents of the diet. The zinc in hair was associated with sex, age, body mass index, and hair color. Using a multivariate analysis, predictive models of multiple regression were obtained for the serum zinc: y = 109.69 — 1.39 (dietary zinc) — 4.63 (sex) — 0.65 (dietary fiber), for the zinc in the serum, and y = 199.34 + 26.62 (sex) — 2.08 (BMI) — 0.47 (age) for the zinc in the hair. The serum concentration decreases as the dietary zinc and fiber decreases and women have lower levels. The zinc in hair is increased in women and is reduced with increasing age and BMI (AU)

[Nutrition and gene expression]. / Nutrición y expresión génica.

The genetic information stored in the DNA is transmitted to an RNA molecule through transcription and protein molecules are obtained from the RNA using translation techniques. Each of the processes forming part of this chain is the object of complex regulation (gene expression regulation). Some nutrients may affect gene expression by taking part in these regulatory mechanisms, such as sterols, glucose, vitamins A, D and B12, various fatty acids or some components of dietary fibre. These phenomena may have come about through the adaptation of the primitive beings to the various changes in the nourishment available. The successive changes over centuries have led to the determination of individuals' phenotypes not only by their genotype but also by environmental factors such as diet. Our genes have adapted to the changing sources of nourishment surrounding our ancestors; modern diets are, however, very different from those of the past. The inability of our genetic store to adapt to modern diets may be the reason for the appearance of certain chronic diseases in developed countries. One well-analyzed case is that of the thrifty genotype which provided evolutionary advantages in the past, but may now be contributing to obesity and diabetes. Further examples of genotype interaction with various environmental factors to produce different phenotypes are provided by the apolipoproteins: some mutations in the genes of these proteins, in combination with different diet types, are associated with altered lipid levels and the risk of various cardiovascular diseases. These diet-genotype interactions mean that it is fundamentally important to take into account the genetic variability of individuals before recommending dietary measures to prevent the so-called "first-world" diseases.

[Nutrition and behavioral eating disorders: anorexia and bulimia nervosa]. / Nutrición y trastornos de la conducta alimentaria (TCA): anorexia y bulimia nerviosa.

Behavioral eating disorders (BED's) have shown an intense growth in the last years. They are considered to be caused by multiple factors, showing a bio-psycho-socio-cultural etiology. Although there are clinical signs that could alert the physician and allow an early diagnosis, their final diagnosis must meet certain criteria set in the DSM-IV (1994). Despite the fact that anorexia nervosa and bulimia nervosa in their typical forms, are the most known, there are atypical or incomplete forms of both that should be kept in mind when making the diagnosis. Anorexia nervosa is accompanied by somatic-nutritional problems that may condition the patient's life, requiring specific nutritional care. Bulimia nervosa is often accompanied by medical complications that require an exhaustive assessment. As for the nutritional support in anorexia nervosa, this must be proportional to the nutritional status of the patient and there should be no hesitation to resort to artificial nutrition using enteral nutrition through a tube in the case of severe malnutrition. In these cases there must be careful monitoring for the appearance of the re-nutrition syndrome, and this can be avoided by the slow and progressive administration of energetic nutrients, with special precautions in the supply of carbohydrates, and administering an adequate supplement of vitamins and electrolytes. Patients with a BED require a multi-disciplinary care with the simultaneous and coordinated action of a team of professionals. This type of care coupled with the experience of the team with regard to BED's and their treatment, and together with other actions and situations, may favor the final prognosis of a patient with a BED.

[Severe gastroesophageal lesions due to caustics: the role of nutritional support]. / Lesiones gastroesofágicas graves por cáusticos: papel del soporte nutricional.

AIM: Describe the clinical-nutritional state of patients with severe digestive lesions after the ingestion of caustic substances, as well as their nutritional support (NS). PATIENTS AND METHODS: We studied 5 patients diagnosed by means of early endoscopy, treated with artificial nutrition, 4 of whom used enteral nutrition. During the acute phase of the disease, an evaluation of the nutritional state (ENS) was done, by means of the following parameters: body mass index (BMI), creatinine/height index (CHI), visceral proteins, nitrogen content of 24 h urine, and plasma zinc level. The corrected Harris-Benedict equation was used to calculate the energy needs. RESULTS: The BMI did not experience significant changes. The CHI decreased in a large degree. The long life visceral protein did not change notably, and those of intermediate and short life increased. The losses of nitrogen were increased. We found hypozincemia in 4 of the cases. The mean Kcal provided was 2323 +/- 105. CONCLUSIONS: In the described patients, given their catabolic condition, and early ENS and NS should be done. If at all possible, the NS shall be enteral, with or without parenteral support. In our study we have found a cessation of the weight loss, a decrease of somatic protein with a short term re-filling of the visceral protein pol. The zinc levels should be monitored.

[Acalculous cholecystitis and intestinal cryptosporidiosis: frequent association in HIV patients]. / Colecistitis alitiásica y cryptosporidiasis intestinal: asociación frecuente en pacientes VIH.

Five cases of acalculous cholecystitis associated with Cryptosporidium intestinal infection in HIV infected patients are reported. Clinical, Biological and Microbiological features as well as imaging studies are described. All the patients were males. Risk factors for HIV infection included previous I.V. drug abuse (3), homosexuality (1) and unknown (1). On admission a similar history of weight loss, fever, abdominal pain, diarrhea, anorexia and asthenia, together with biological data of cholestasis, was present in all patients. Ultrasound studies showed a distended gallbladder without calculi and a thickened wall, the bile duct being dilated in four of five cases. Cryptosporidium were found in stool specimens of all patients as well as histologically in one of two patients who underwent surgery while CMV was shown in the other one. Endoscopic retrograde cholangiography was performed in four cases showing a congestive, edematous and protruded papila in three patients, being normal in the fourth with a choledocal stenosis.

Effect of fasting, hypocaloric feeding, and refeeding on the energetics of stimulated rat muscle as assessed by nuclear magnetic resonance spectroscopy.

A previous study suggested that muscles from hypocalorically fed rats were limited in their ability to rephosphorylate ADP. During muscle contraction hydrolysis of ATP results in an increase in phosphorus, free ADP, delta GATP, and a reduction in phosphocreatine levels that is reversed during rest by rephosphorylation of ADP to ATP and the resynthesis of phosphocreatine by ATP. We therefore hypothesized that these changes would be restored more slowly during postcontraction rest in hypocalorically fed rats as compared with controls. We compared controls fed ad lib to 2-d fasted and hypocalorically fed rats, losing 20% of their weight. We also compared hypocalorically fed rats that had been refed ad lib for 7 d with age-matched controls fed ad lib. The results showed that ATP, muscle pH, and total muscle creatine levels were not different in all groups. The raised phosphorus and delta GATP levels and lower phosphocreatine/phosphorus ratio at the end of contraction changed more slowly during rest in the hypocaloric rats. These abnormalities were partially corrected by refeeding. The data taken as a whole support the concept of impaired rephosphorylation of ADP in malnourished muscle that is not completely restored by refeeding in stimulated muscle.